title: Preoperative treatment of locally advanced esophageal carcinoma (Review).
abstract: Esophageal cancer (EC) is an aggressive malignancy with increasing incidence worldwide. Surgery is still the most effective treatment, however, both the high rate of local and distant recurrences and surgery-related complications led us to investigate new preoperative strategies. In this review, we discuss the role of neoadjuvant therapy for locally advanced EC with a focus on preoperative chemoradiation (trimodality treatment). Furthermore, the last fifteen years of published literature and our experience have been also reviewed. In the preoperative setting, few trials have reported a significant benefit with fluoropyrimidine and platinum compound-based neoadjuvant chemotherapy, compared to surgery alone. A large number of phase III trials and meta-analyses have demonstrated improved outcomes with preoperative chemoradiation vs. neoadjuvant chemotherapy or surgery alone. Therefore, trimodality therapy can be considered the most effective option in the management of locally advanced EC. Addition of drugs targeting VEGF or HER2 to standard chemotherapy appears to be feasible but needs to be explored more accurately. FDG-PET may predict both response to neoadjuvant treatments and prognosis.
authors.affiliation: Division of Medical Oncology, 'F. Magrassi - A. Lanzara' Department of Clinical and Experimental Medicine and Surgery, Second University of Naples, School of Medicine, Naples, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Orditura
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galizia
authors.forename: Alessio
authors.initials: A
authors.lastname: Fabozzi
authors.forename: Eva
authors.initials: E
authors.lastname: Lieto
authors.forename: Valentina
authors.initials: V
authors.lastname: Gambardella
authors.forename: Floriana
authors.initials: F
authors.lastname: Morgillo
authors.forename: Gian Mattia
authors.initials: GM
authors.lastname: Del Genio
authors.forename: Landino
authors.initials: L
authors.lastname: Fei
authors.forename: Natale
authors.initials: N
authors.lastname: Di Martino
authors.forename: Andrea
authors.initials: A
authors.lastname: Renda
authors.forename: Fortunato
authors.initials: F
authors.lastname: Ciardiello
authors.forename: Ferdinando
authors.initials: F
authors.lastname: De Vita
mesh_terms: D059186:Chemoradiotherapy, Adjuvant; D003131:Combined Modality Therapy / Q000379:methods*; D004938:Esophageal Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000601:surgery; D006801:Humans; D058990:Molecular Targeted Therapy; D020360:Neoadjuvant Therapy; D011300:Preoperative Care / Q000379:methods*; D016896:Treatment Outcome